Knee Cartilage Injuries in Football Players: Clinical Outcomes and Return to Sport After Surgical Treatment: A Systematic Review of the Literature

Author:

Andriolo Luca1ORCID,Marín Fermín Theodorakys2ORCID,Chiari Gaggia Giulia Marcella Maryse3,Serner Andreas4,Kon Elizaveta35,Papakostas Emmanuel6ORCID,Massey Andrew4,Verdonk Peter678,Filardo Giuseppe91011

Affiliation:

1. Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

2. Centro Profesional Las Mercedes, Caracas, Venezuela

3. IRCCS Humanitas Research Hospital, Milan, Italy

4. FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland

5. Department of Biomedical Sciences, Humanitas University, Milan, Italy

6. Aspetar Orthopaedic & Sports Medicine Hospital, Doha, Qatar

7. ORTHOCA, Antwerp, Belgium

8. Department of Orthopaedic Surgery, Antwerp University Hospital, Edegem, Belgium

9. Service of Orthopaedics and Traumatology, Department of Surgery, Ente Ospedaliero Cantonale, Lugano, Switzerland

10. Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

11. Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland

Abstract

Objective To systematically review the literature and analyze clinical outcomes and return-to-sport after surgical management of cartilage injuries in football players. Design A systematic literature review was performed in August 2023 on PubMed, WebOfScience, and Cochrane Library to collect studies on surgical strategies for cartilage lesions in football players. Methodological quality and risk of bias were assessed with the modified Coleman Methodology score and RoB2 and RoBANS2 tools. Results Fifteen studies on 409 football players (86% men, 14% women) were included: nine prospective and two retrospective case series, one randomized controlled trial, one prospective comparative study, one case report, and one survey. Bone marrow stimulation (BMS) techniques were the most documented. The lesion size influenced the treatment choice: debridement was used for small lesions (1.1 cm2), BMS, osteochondral autograft transplantation (OAT), matrix-assisted autologous chondrocytes transplantation (MACT), and scaffold-augmented BMS for small/mid-size lesions (2.2-3.0 cm2), and autologous chondrocytes implantation (ACI) for larger lesions (5.8 cm2). The surgical options yielded different results in terms of clinical outcome and return-to-sport, with fastest recovery for debridement and scaffold-augmented BMS. The current evidence is limited with large methodological quality variation (modified Coleman Methodology score 43.5/100) and a high risk of bias. Conclusions Decision-making in cartilage injuries seems to privilege early return-to-sport, making debridement and microfractures the most used techniques. The lesion size influences the treatment choice. However, the current evidence is limited. Further studies are needed to confirm these findings and establish a case-based approach to treat cartilage injuries in football players based on the specific patient and lesion characteristics and the treatments’ potential in terms of both return-to-sport and long-term results. Level of evidence Systematic review, level IV.

Publisher

SAGE Publications

Reference48 articles.

1. FIFA Communications Division. Information Services. 2017. Available from: https://digitalhub.fifa.com/m/55621f9fdc8ea7b4/original/mzid0qmguixkcmruvema-pdf.pdf

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